The landscape has changed since Gov. John Kasich signed Ohio's medical marijuana law one year ago today.

Details of the new, tightly-controlled program began rolling out in November. The state began accepting applications for 24 grow licenses on Monday, and other businesses are preparing to apply for dispensary and processor licenses in a few months.  

Several cities and villages that passed moratoriums or temporary bans on marijuana businesses have decided to allow them, usually after being approached by a potential business promising jobs and tax revenue.

But much remains the same.  

Patients still can't buy legal marijuana here, and doctors can't become certified to recommend it. No licenses have been awarded to marijuana cultivators, processors, testing labs or dispensaries. Some details about the program are still unknown.

Here's where we stand.

A two-year process 

The law, which went into effect in September, set the framework for the medical marijuana program: patients with one of 21 medical conditions could buy and use marijuana if recommended to them by a physician. Smoking marijuana and growing it at home were not allowed in the law.         

But details, including who would grow and sell marijuana, were left to three agencies to work out before September 2017. State officials say dispensaries will open by the statutory Sept. 8, 2018 deadline. 

So while it seems to be taking a long time to set up, state officials are on track to meet their deadlines. 

Rules and regulations for cultivators were finalized in April, and the rest are nearing the end of the process. 

The lay of the land 

The state plans to license up to 24 cultivators (12 for up to 3,000 square feet of growing space and 12 for up to 25,000 square feet), 40 processors that will make marijuana oils, tinctures, patches and edible products allowed by law, 60 dispensaries and an unknown number of testing labs. 

Cultivator licenses will be awarded based on how they plan to grow marijuana, staff and secure their facilities and comply with state regulations. 

The application process is complicated, and state-imposed fees are steep. For example, larger cultivators will pay a $20,000 nonrefundable application fee and a $180,000 license fee if selected, renewable for $200,000 a year. 

That's not stopping entrepreneurs, many with the help of out-of-state consultants, from applying.

An Ohio Department of Commerce spokeswoman declined to say Wednesday how many applications have been received or been scheduled for receipt. But Pennsylvania received more than 500 applications for a dozen medical marijuana cultivator/processor licenses and 27 dispensary permits.

Some cities eager for business, others sitting out 

Ohio's law allows cities, villages and townships to limit the number of marijuana businesses or ban them altogether. More than 50 municipalities have passed temporary or permanent bans: some because of public safety concerns, others wanting to see what decisions state officials make. 

Businesses cannot apply for a license for a site where a moratorium or ban is in place. The cultivator application also requires a local zoning official to sign a form indicating the applicant has applied for local permits. 

So communities that haven't lifted their bans by the end of June won't be home to a cultivator unless state officials decide in September 2018 to add licenses. 

In recent months, more than a dozen communities have lifted those bans or let them expire. The driving factor: Entrepreneurs and investors want to start businesses there. 

Youngstown gave its approval to five cultivator applicants Wednesday night. Columbus and Johnstown have each signed off on six applicants. Lorain, Painesville, Eastlake and Richmond Heights have given their blessing to cultivator applicants eyeing underutilized city property. 

Johnstown was the first Ohio community to open its doors to potential medical marijuana businesses last year and lined up so many potential cultivators it ran out of eligible land to grow on. But it almost lost them all when village council members were mulling a hefty local licensing fee and tax on top of state fees and taxes. 

Interested businesses balked at the proposal, noting several communities are welcoming marijuana businesses to its empty business parks and vacant lots without tacking on high fees. The village opted to tax 1 percent of net profits -- the same as any other business and lower than neighboring Columbus' 2.5 percent.

"Even if you're welcoming, there are other communities who are welcoming now," Johnstown Village Manager Jim Lenner said. "We're hoping that not only being welcoming but having a lower tax rate will benefit us." 

Patients left waiting 

Lawmakers recognized it could take two years before legal marijuana was available for patients and built in a safeguard intended to allow patients to use medical marijuana without being prosecuted for possession. 

Patients with qualifying conditions, who comply with the possession and paraphernalia parts of the law, have an affirmative defense in court if they have a letter or other paperwork certifying compliance and signed by an Ohio physician. But the law didn't say where patients could get marijuana. 

Doctors have been reluctant to sign off on paperwork before becoming certified by the state. The certification process is not yet in place, and no continuing education courses -- required to become certified -- have been approved. Only about 7 percent of Ohio physicians said they would be willing to recommend medical marijuana and their hospital or employer would allow them to, according to a state medical board survey of Ohio doctors.

There's only been one known case of an affirmative defense letter being used. The Bedford police chief told the Associated Press charges were dropped against the man because the illegal substances found didn't match the search warrant. 

Amanda Candow, a Mentor woman who has multiple sclerosis, has a letter but doesn't know how much she can trust it. Candow said patients like her want to be on the right side of the law, and many, including terminal cancer patients, don't want to buy illegal marijuana. 

"Everything is so vague and when you're a patient, it feels personal -- why are they doing this to me still?" Candow said. "I didn't choose to have MS or choose to have super tight muscles when I wake up in the morning, and the one thing that gives me relief I can't have." 

Candow wants lawmakers to clarify the law for physicians or institute something like Pennsylvania's safe harbor letter, which only requires a doctor certify that a patient has a qualifying condition. More than 200 children have been approved for safe harbor. 

Time for changes 

Rep. Kirk Schuring, a Canton Republican who worked on the law, said he's willing to make changes as necessary to ensure the program serves patients.  

One change is already in the works. The state budget bill passed by the House removes a requirement that doctors certify the benefits of medical marijuana outweigh the risks. Schuring said that's nearly impossible for physicians and not something they do in recommending other treatments. 

"It wouldn't be the first time in the legislative process that a bill that isn't implemented how we envisioned it," Schuring said. "I'm committed to making sure the program works."